Providers have gone to the State Board of Medical Licensure in recent months to complain about the board's proposed prescription rule changes. And they make at least one really compelling point:

"Why aren't we just going after the pill mills and overprescribers?"

To address the opioid epidemic, partly the result of overprescribing doctors, the board has proposed regulations that attempt to limit prescription amounts. They would also require doctors to conduct drug tests, to get better information from their patients, before prescribing opioids and benzodiazapines like Xanax and Valium.

Instead of addressing "bad doctors," some providers say, the board is trying to insert itself into the doctor-patient relationship and tell all doctors how to practice. The regulations also portray physicians as "mistrusted, clueless pill pushers," said one psychiatrist.

In fact, the Board of Medical Licensure has the information it needs to identify the highest-prescribing doctors and those prescribing more than could be possibly connected to actual examinations and reasonable care.

It's called the Mississippi Prescription Monitoring Program, and it is supposed to document all prescriptions written in the state.

Only, board members say, they don't have the authority to go randomly digging around in the PMP, as that would be tantamount to a trooper pulling over a motorist for no reason.

The board, which is tasked with investigating doctors across the state, is a complaint-based agency. Unless the board gets information about a doctor from a reliable source, his or her PMP information won't be pulled.

In hearings, some medical professionals have suggested setting up the PMP to red flag names once they've met a certain prescribing threshold (this ignores the fact there is no regulation currently restricting prescription amounts, so the board would have no ability to cite doctors for simply overprescribing in their normal scope of practice).

Before burdening "good doctors," they suggest, the board should start with actively identifying the outliers, the ones who need to correct their behavior.

That suggestion concerns Rep. Joel Bomgar, R-Madison, one lawmaker who's been studying the opioid problem and opposes the board's approach.

How would you set the threshold? What about exceptions, doctors with many pain patients? Patients who legitimately need high dosages of opioids, or at least are already addicted?

Bomgar said this could have a chilling effect and result in doctors simply dropping their most prescribed patients in an attempt to avoid being an outlier. His main concern is that those patients will go to the street, seek out even more dangerous drugs and ultimately result in more deaths in Mississippi.

This is, in general, the most compelling argument against the proposed regulations. Even State Health Officer Mary Currier cautioned the board about the potential.

It's important to note the proposed rules do not prohibit prescribing opioids for long-term chronic pain if the doctor can document no other remedy has worked. They also do not require doctors to cut patients off if a drug test indicates a drug abuse issue.

Bomgar doesn't object to the proposed prescriptions limits. But even if the regulations don't explicitly prohibit doctors from continuing to prescribe opioids, he said they'll have that effect. Some doctors have already stopped in anticipation of the crackdown.

Even now that the board has tweaked the proposed language to give doctors more leeway to continue prescribing to a patient who is addicted if the doctor can document the legitimacy, Bomgar asks: how many doctors know that?

It's as if the well is already poisoned.

"Doctors are running scared," Bomgar said.

The irony with doctors concerned they'll lose their license if they continue upholding ethical care and prescribing for legitimate reasons is that the board itself is pretty lenient.

Another doctor pleaded guilty in federal court to illegally prescribing a controlled substance outside the scope of his practice. He also kept his license, under the order that he take an ethics course and adhere to PMP requirements.

Another kept his license under a consent order after it was discovered he left presigned prescription pads in his office for his nurse to issue. Through a law enforcement investigation, another was found to have been prescribing to friends and family. He and another doctor accused of improperly prescribing resigned their DEA licenses and were never addressed by the board.

Dr. Heddy-Dale Matthias, who complained before the board in an October hearing about its "sledgehammer approach" to addressing opioid prescriptions, has changed her tune.

In further studying the regulations, she now believes they'll simply compel physicians to be more thoughtful about their treatment of pain. Because this is about more than "bad doctors" and "pill mills," she said.

"(Pill mills) are easily found on the PMP and obvious to everybody. Everyone believes pill mills are bad and should be shut down. They have nothing to do with pain management or ethical treatment of patients. There are a small number but they're real," Matthias said. "Another part of the problem is, in general, some legitimate overprescribing that physicians do without a lot of thought because it has been the way we've practiced medicine for a long time ... The prescribing of too many pills for post-operative pain relief, which end up in somebody's medicine cabinet. That's not something that's going to be identified in the PMP."

Ultimately, the proposed rules are still in the public comment phase. The Medical Licensure Board will have another public hearing March 7.

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